Impacts of Financial Coverage on Long-Term Outcome of Intensive Care Unit Survivors in South Korea

Abstract

PurposeThe objective of this study was to investigate whether financial coverage by the national insurance system for patients with lower economic conditions can improve their 1-year mortality after intensive care unit (ICU) discharge.Materials and MethodsThis study, conducted in a single tertiary hospital, used a retrospective cohort design to investigate discharged ICU survivors between January 2012 and December 2016. ICU survivors were classified into two groups according to the National Health Insurance (NHI) system in Korea: medical aid program (MAP) group, including people who have difficulty paying their insurance premium or receive medical aid from the government due to a poor economic status; and NHI group consisting of people who receive government subsidy for approximately 2/3 of their medical expenses.ResultsAfter propensity score (PS) matching, a total of 2495 ICU survivors (1859 in NHI group and 636 in MAP group) were included in the analysis. Stratified Cox regression analysis of PS-matched cohorts showed that 1-year mortality was 1.31-fold higher in MAP group than in NHI group (hazard ratio: 1.31, 95% confidence interval, 1.06 to 1.61; p=0.012). According to Kaplan-Meir estimation, MAP group also showed significantly poorer survival probability than NHI group after PS matching (p=0.011).ConclusionThis study showed that 1-year mortality was higher in ICU survivors with low economic status, even if financial coverage was provided by the government. Our result suggests the necessity of a more nuanced and multifaceted approach to policy for ICU survivors with low economic status.

Effects of tertiary palliative care on the pattern of end‐of‐life care in patients with hematologic malignancies in Korea

“…However, the ICU admission rate was 25% in our study, substantially higher than the rate of 11.3% in PC‐referred patients with solid tumors 40 . Cultural differences from Western countries and the relatively lower cost burden on individual patients for ICU care in Korea owing to wide insurance coverage may be the reasons for high ICU admission rates 41 . In addition to PC consultation, initial disease risk was also significantly associated with ICU care in the last 30 days of life and death in the ICU.…”

“…Cultural differences from Western countries and the relatively lower cost burden on individual patients for ICU care in Korea owing to wide insurance coverage may be the reasons for high ICU admission rates. 41 In addition to PC consultation, initial disease risk was also significantly associated with ICU care in the last 30 days of life and death in the ICU. Notably, having a low initial disease risk was linked to a higher odds ratio for both ICU care and death in the ICU.…”

Association of Economic Status and Mortality in Patients with Acute Respiratory Distress Syndrome

“…Our results suggest that economic status prior to diagnosis of ARDS is not a significant factor when considering the prognosis of ARDS patients treated within the NHIS system of South Korea. These findings are important, as the NHIS system in South Korea covers 2/3's of the total medical costs for the general population [15], increasing the coverage to 100% for groups that require financial support [16]. In contrast to previous studies reporting on the impact of individuals' income on their ARDS-related prognosis within different health insurance systems [13,14], we present evidence that income might not be an important prognostic factor for ARDS patients, given suitable public health insurance coverage.…”

Predictive value of modified systemic inflammation score for postoperative unplanned ICU admission in patients with NSCLC

“…Therefore, patients need to be admitted to the ICU to manage severe complications and obtain enhanced life support. Patients admitted to the ICU are in critical condition and have a poor prognosis and an increased risk of short-term death, which leads to the prolongation of postoperative hospital stay and imposes a substantial economic burden ( 6 ). The aims of this study were to identify patients at high risk of unplanned ICU admission by exploring the influencing factors of unplanned ICU admission and to intervene in advance to reduce the proportion of patients with unplanned ICU admission.…”